Information Collection

HH Demo for Mailed Requests (Michigan and Massachusetts)

IC 222825 under ICR 201606-0938-007 · OMB 0938-1311.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1311 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PCRD_HH_Operational_Guide.pdf	Instruction

IC Title:

HH Demo for Mailed Requests (Michigan and Massachusetts)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			PCRD_HH_Operational_Guide.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 795

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	21,828	21,828
Annual IC Time Burden (Hours)	10,914	10,914
Annual IC Cost Burden (Dollars)	109,140	109,140

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.